Spine and spinal injuries relatively affect young people and have significant socio-economical problems with their results. Spinal injuries are generally caused by the fractured bone after spinal fractures narrowing the canal in which the spine passes. Rarely, it may be caused by excessive straining of the spine without any bone fracture in children.
Spinal fractures or injuries may be at any location on the spine from the neck to the tail end. The severity of spinal injuries may vary from a mild soft tissue trauma to spinal fracture and spinal injuries. Spinal fractures and dislocations may cause spinal injury and accordingly paralysis. The treatment also varies depending on the severity of the case.
5-10% of the fractures occur in cervical vertebrae, 70% in dorsal and lumbar vertebrae and the remaining in the lower part. The most injured areas are the most moving area of the spine where dorsal and lumbar vertebrae joint (12th dorsal vertebra and 1st lumbar vertebra, T12 and L1).
Spinal fractures can be in 3 ways.
Fractures: If a bone carried a load more than the amount it can carry, this bone fractures. The most common type of fracture is “compression fracture” where the front side of the spine collapses. If the load on the spine is more severe, in that case, mid and posterior of the spine may fracture, fragments move towards spinal canal and damage spinal cord. This type of fracture is called “blowout fracture”. In blowout fractures, spinal injuries and paralysis are often observed, however, every blowout fracture does not cause paralysis or spinal injury. Generally, fracture occurs in one vertebra, however, 20-30% of the cases may contain more than one sequential or non-sequential vertebrae.
Dislocation and/or Fractures-Dislocations: If the load carried by the spine gets more severe, injuries may occur in the soft tissues, disc, and ligaments that connect the vertebrae and hold them together. In that case, the liaison between two vertebrae break off and spine dislocation occurs. While spinal dislocation is rarely observed as the only dislocation caused by injury of ligaments, often, it is observed as dislocation with fractures due to spinal fracture. In these two types of injuries, spinal injury generally develops and it is the most dangerous injury type. Also, the recovery of dislocation and dislocation with fracture is harder than only fracture. Therefore, dislocation or dislocation with fracture generally requires surgical treatment.
What are the symptoms?
In the early stage, symptoms differ depending on severity and location of the injury. Primary symptoms are the neck, back, low back pain, muscle spasm.
If there is also spinal injury, various complaints such as numbness, sensation loss in arm and/or legs, power loss, urinary, fecal incontinence, inability to urinate or defecate.
In the late stage, in patients who do not have nerve injury, if sufficient treatment is not applied, the most common complaint is kyphosis in the spine and accordingly severe pain. Patients having nerve injury suffer from paralysis and its problems.
What are the primary reasons?
Generally, it is caused by high-energy trauma. A traffic accident is the most common reason. Except for this, primary reasons are falling down from height, firearm injuries, sports accidents. In old patients having osteoporosis, in patients having a spinal tumor, severe fractures may occur even after low-energy traumas such as mild falling down as vertebrae get weaken due to disease.
How is it diagnosed?
It is essential to take the patient to the hospital as soon as possible after spinal injury, and the way in which this procedure is carried out is very important. The most correct way for transport is to wait for the ambulance and specialist personnel. Incorrect way of carrying the patient is one of the most important factors affecting the injury. After the patient is brought to the emergency, physicians carry out the first intervention and examination and may request surveys to make the diagnosis.
Direct radiography (x-ray): It is the first examination to be performed for the patients suspected of injury. Generally, the presence of the injury is shown in a successful way.
Computed tomography: It displays the fractures better than an x-ray.
It is performed in the patients as a routine. In other cases, it may be requested to evaluate the severity and type of the fractures observed in the x-ray.
Magnetic resonance imaging (MRI): It is a good method to evaluate the spinal cord and soft tissues. It is not necessary for every patients, however it may be requested in order to evaluate severity of the fracture and condition of the soft tissue in patients with fractures determined. In addition, it may be requested for the spinal injuries of which reason is not known or in the cases where spinal injury and spinal fracture levels are not compatible.
What are the treatment principles?
In patients who do not have spinal injury, the treatment aims to control the pain and to ensure the integrity of the spine. In an injured spine, primary aims are to prevent the damage to cause kyphosis by time or to prevent any injury which may be caused by kyphosis. Therefore, even though the patient does not have spinal injury, it may be necessary to apply a surgical treatment by evaluating various criteria depending on imaging results. In patient having spinal injury, conditions such as bone compression, spinal cord compression causing injury are tried to be corrected. Early application of this treatment is very important especially in paretic patients. Because, paretic patients have a higher recovery chance. Completely paralyzed patients have less chance for recovery. However, for early rehabilitation of these patients, it is necessary to immediately repair the spine and regain the integrity of the spine.
Which treatments can be applied?
Corset or plaster treatment: Fixation is necessary for the recovery of the fractures.
Especially for compression fractures, corset or plaster treatment is preferred for patients who do not have spinal injury and soft tissue-ligament injury. It is aimed to ensure the recovery of the fracture with exterior fixation and to prevent more compression of the spine, causing spinal compression and to prevent kyphosis. Plaster or corset period is generally 3 months. However, the fracture may not respond this treatment. Even after months, or sometimes years, kyphosis may occur and surgery may be required.
Surgery: It is transfixing and fixation of the fractured spine with metal instruments. This procedure can be carried out on anterior or posterior of the spine or sometimes it may be required to transfix the both sides. At the same time, in patient having spinal injury, fragments compression the spinal cord can be removed during surgery. It is preferred for blowout fractures where there is not nerve injury but posterior ligaments are injured and for other blowout fractures with nerve injury or for fractures and dislocations with fracture.
Vertebroplasty & Kyphoplasty (Cement injection into vertebra): It is a closed surgery method which can be applied for some compression fractures,fractures caused by osteoporosis or spinal tumors and some blowout fractures. It can be be applied under local anesthesia. It is based on the correction of the fracture by entering with wide needles through small incisions made on the skin and injecting cement to strengthen. It can be applied for osteoporotic fractures or fractures caused by spinal tumors. It is insufficient or ineffective for spinal fractures caused by trauma. Vertebroplasty and kyphoplasty are explained in detail in the article “Osteoporotic fractures”.